It's About Time: Use of Nonpharmacological Interventions in the Nursing Home

Purpose: To provide a stronger evidence base for cultural change in the nursing home, this study elicited nursing, recreational therapy, and medical staff perceptions of barriers to the implementation of nonpharmacological interventions for the behavioral and psychological symptoms of dementia (BPSD). Design: Thirty-five staff members (registered nurses, licensed practical nurses, nurses' aides, recreational therapists, activity personnel, and medical directors) from six nursing homes located in Pennsylvania and North Carolina participated in the qualitative study. Methods: A focus group methodology was used to capture discussions that were audio-recorded and transcribed verbatim. Data were analyzed using standard methods of content and thematic analysis. Findings: Four broad themes were identified: the changing landscape; resident behaviors; reaching out to the person with dementia; and the educational needs of staff. The concept of time emerged as a key barrier to the use of nonpharmacological interventions for BPSD. Conclusions: Successful use of nonpharmacological interventions requires the right staff with the right education at the right time. The Vulnerability Framework is a model that helped organize these findings into a meaningful perspective. Clinical Relevance: To effect change in the nursing home, the findings indicate a need for: implementation of staffing patterns that allow staff the time to make a difference in the care of residents with BPSD; development of educational programs that promote staff understanding versus control; and design of research studies that answer questions about the influence of time on the selection of interventions for BPSD.